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Biomedical subjects

C Campisi

Publications and source records attributed to C Campisi.

At least 19 recordsLinked to original sources
PubMed1999

Use of Thermotherapy in Management of Lymphedema: Clinical Observations.

We report clinical observations in 67 patients with chronic lymphedema undergoing hyperthermia. Our technique of hyperthermia is an alternative to microwave therapy, particularly where lymphangitis coexists in the same limb. Preoperative diagnostic evaluation including lymphatic and venous isotopic scintigraphy, Doppler venous flow metrics, and pressure manometry play an essential role in delineating the status of both the lymphatic and venous systems and in determining if hyperthermia is indicated. Our method of treatment consists of producing hot and humid ambience inside the chamber where the limb is situated. The data demonstrate the feasibility of our method of hyperthermia in 67 patients with postlymphangitis lymphedema (either arm or leg). Using this technique, improvement was seen in both limb function and edema.

Journal Article↗
PubMed1999

Carboplatin, ifosfamide, and vinorelbine in the treatment of advanced non-small-cell lung cancer: a phase II study.

The authors evaluated the efficacy and toxicity of the combination of carboplatin, ifosfamide, and vinorelbine in the treatment of advanced non-small-cell lung cancer. From March 1994 through March 1996, 56 previously untreated patients with stage IIIB or stage IV non-small-cell lung cancer with measurable lesions and good performance status were entered in the study. The chemotherapy schedule was as follows: carboplatin 100 mg/m2 and ifosfamide 1,500 mg/m2 with mesna on days 1, 2, and 3; vinorelbine 25 mg/m2 on days 1 and 8, every 21 days; for a total of six courses. Among 55 evaluable patients there were three complete responses (5%) and 22 partial responses (40%), for a response rate of 45% (95% confidence interval, 32-59%). The median response duration was 10.3 months (range, 2.5-27.7 months), and median survival time was 11.3 months (range, 1.1-28.1 months). The survival rate at 1 year was 48%. Toxicity included hematologic toxicity in 60% of the 247 treatment cycles administered, nausea, alopecia, and neuropathy. One pathologic complete response was observed in a patient with stage IIIB disease who became operable after four courses of chemotherapy. The outpatient treatment with carboplatin, ifosfamide, and vinorelbine shows activity in advanced non-small-cell lung cancer. The toxicity was well tolerated by patients with a good performance status.

Adult↗
PubMed1999

Chylous reflux pathologies: diagnosis and microsurgical treatment.

BACKGROUND: This article aims to make a contribution to the present knowledge of the diagnosis and therapy of chylous reflux pathologies, based largely on the authors' clinical experience in the microsurgical treatment of these disorders. METHODS: In 47 patients affected by chylostatic disorders the diagnosis was based on the clinical history, physical examination, lymphoscintigraphy, lymphography, ultrasound, CT scanning and lymphangio-MR. In cases of chylous reflux towards the external genitalia or the lower limbs, the puncture of one of the lymphostatic verrucae which may be part of the symptomatology, can be sufficient for the clinical diagnosis. If patients suffer from hypoproteinaemia and/or an intestinal malabsorption syndrome, this should be dealt with to ensure them at least temporary metabolic compensation before surgical treatment, if any. In patients affected by chylous ascites, antigravitational ligatures of incompetent collectors, sometimes associated with lymphovenous shunts, can be a therapeutic solution. RESULTS: We have found that CO2 laser irradiation at very low power achieved full section closure of lymphatic and chylous vessels as complete as if they had been tied. In the case of chyloedema of the external genitalia and of/or the lower limbs, reductive plastic treatment completes the result after antigravitational ligatures and derivative microsurgery. CONCLUSIONS: A laser-microsurgical technique used to manage chylous reflux pathologies achieved positive and permanent results, especially after an accurate preoperative diagnostic study to determine the site and nature of the lymphatic and chylous leakage and associated disorders.

Chyle↗
PubMed1999

Lymphoedema: modern diagnostic and therapeutic aspects.

The author reports his clinical experience regarding the diagnostic assessment of patients with lymphedema and the selection criteria for those assigned to microsurgery. Patients were classified according to aetiology and stages and sites of the lymphedema and underwent a diagnostic protocol consisting of lymphoscintigraphy, lymphography (in selected cases), Doppler venous flowmetry and manometry, lymphangio-RM and, in the case of angiodysplasias, phlebography and arteriography. This protocol is essential in deciding the appropriate microsurgical technique in those selected for surgery, whether derivative lympho-venous anastomosis or reconstructive lymphatic-venous-lymphatic plasty. The results of surgery were assessed both clinically (with the aid of photographs, water volumetry and measurements of limb circumference) and by lymphangioscintigraphy, and were classified as marked, moderate or mild regression of oedema. The overall results were very encouraging, particularly those of patients in the earlier stages of the condition. With regard to secondary prevention, early diagnosis plays an important role as does the identification of patients at high risk for the onset of lymphostatic disease after oncological lymphadenectomies, especially when associated with radiotherapy. In such cases, in order to combat right from the outset those lymphedemas which, based on statistical probability, are expected to show unrelenting progression if untreated, early microsurgery is a reasonable option.

Angiography↗
PubMed1999

Role of microsurgery in the management of lymphoedema.

BACKGROUND: Microsurgical techniques in the treatment of peripheral lymphoedema proved to be very promising, the authors' clinical experience with derivative and reconstructive lymphatic microsurgical operations was analysed. METHODS: From 1973 to 1997, 843 patients were studied and treated by microsurgical methods, with average follow-up of over 5 years. Microsurgical techniques mostly consisted of derivative lymphatic-venous or lymphatic-capsule-venous anastomoses and reconstructive autologous vein interpositioned grafts (lymphatic-venous-lymphatic-plasty). Ninety percent of patients were operated on at the II-III stage, 3% at the I and 7% at the IV-V stage. Limb volumes were measured using the water displacement technique and lymphoscintigraphy was used to accurately assess the structural and functional status of the lymphatic drainage before and after variable distances of time after microsurgery. More recently, also lymphangio-MR was used to accurately evaluate changes in the lymphoedematous extremity before and after treatment. RESULTS: Postoperatively, all the patients had a reduction of oedema variable above all according to the stage of the pathology at the time of microsurgical operation. Short and long-term results were positive, as concerns both volumetric oedema reduction and arm function, besides the regression of annual incidence of acute lymphangites. The efficacy of microsurgical lymphatic operations has been verified, moreover, by lymphoscintigraphy. CONCLUSIONS: Microsurgical techniques permit, today, the solution of complex clinical patterns not only of secondary but also of primary, unilateral and bilateral, lymphoedemas, at different stages, with better results the more precocious the microsurgical treatment is, with stabilization of the result also at long distance of time from operation.

Adolescent↗
PubMed1999

A lymph nodal capillary-cavernous hemangioma.

A capillary-cavernous hemangioma in an obturator lymph node was found incidentally in a 64 year-old woman who had undergone unilateral salpingo-oophorectomy and lymphadenectomy for an ovarian neoplasm. Vascular tumors of lymph nodes are briefly reviewed including eight previously described nodal capillary-cavernous hemangiomas. The association with other splanchnic hemangiomas is pointed out and the likelihood that the lesion is a hamartoma rather than a true neoplasm is addressed. Despite its rarity, this entity needs to be recognized by lymphologists who image lymph nodes by lymphangiography as well as by lymph nodal pathologists.

Cystadenocarcinoma, Papillary↗
PubMed1998

Frontiers in lymphatic microsurgery.

The Authors report an overview on the modern surgical treatment of peripheral lymphoedema. The aim of lymphatic microsurgical operations is to drain the lymph either toward the venous circulation (lympho-venous shunts) or the lymphatic collectors above the obstacle to the lymph flow, with the interposition of lymphatic or venous grafts (lymphatic-venous-lymphatic plasty). Selection of candidate patients for lymphatic microsurgery is based on an adequate diagnostic investigation, which includes above all lymphoscintigraphy, conventional oil contrast lymphangiography, Doppler venous flowmetry and manometry, and, if necessary (angiodysplasias), an accurate study also of the artery circulation. The clinical outcome of lymphatic microsurgery, assessed by water volumetry and lymphangioscintigraphy, performed at variable distance of time from operations till over 5 years after surgery, shows a significant reduction of edema volume and improvement of lymph flow in all patients and that the more precocious the microsurgical treatment the better the results.

Anastomosis, Surgical↗
PubMed1998

Ifosfamide given by continuous-intravenous infusion in association with vinorelbine in patients with anthracycline-resistant metastatic breast cancer: a phase I-II clinical trial.

BACKGROUND: Vinorelbine (VNR) is highly active in metastatic breast cancer (MBC) and has shown an overall response rate of 40%-50% as first-line treatment. In vitro, a synergy has been observed between this drug and ifosfamide (IFX). In addition, the pharmacokinetics of IFX suggest that it may have greater activity when given by continuous-intravenous infusion (c.i.v.i.). The aim of this study was, therefore, to assess the antitumor efficacy and toxicity of the combination of bolus VNR and c.i.v.i. IFX as second-line therapy in anthracycline-resistant breast cancer patients. PATIENTS AND METHODS: Forty-two patients with MBC who had already received anthracycline-based chemotherapy were treated with a regimen consisting of IFX, by c.i.v.i. for 72 hours and bolus VNR. The courses were repeated every three weeks for a maximum of eight cycles. Four dose intensification steps were planned: IFX, 1.5 g/m2 on days 1-3 + VNR, 30 mg/m2 on day 1 (six patients); IFX, 2 g/m2 on days 1-3 + VNR, 25 mg/m2 on day 1 (six patients); IFX, 1.8 mg/m2 on days 1-3 + VNR, 25 mg/m2 on days 1 and 8 (six patients); IFX, 2 g/m2 on days 1-3 + VNR, 25 mg/m2 on days 1 and 8 (24 patients). Sodium-2-mercaptoethane sulfonate (mesna) was associated with IFX at an infusion ratio of 1:1 and, once the infusion was completed, per os every four hours for three times. RESULTS: All of the 42 patients entered were assessable for toxicity, and 41 of them for response. Neutropenia was the most frequently-occurring toxicity, but only five patients at the highest dose level (11.9%) presented grade 4, and none of those at the first three steps. Other significant toxic effects were mild (only grade I-II). The median relative dose intensity was 95% at the highest dose level and all of the treatments were administered on an out-patient basis. The overall response rate was 36.5% with a CR rate of 4.8% (two of 41 patients, all at the highest dose level) and a PR rate of 31.7% (13 of 41 patients). The median response duration was 7.0 months (range 2-13 months). CONCLUSIONS: The present phase I-II study shows that the IFX and VNR combination is an active and well-tolerated treatment in MBC and provides an alternative to taxanes for patients previously treated with anthracyclines.

Adult↗
PubMed1996

[Physical training and low-dose heparin-calcium in patients suffering from chronic obliterating arteriopathy of the lower limbs with intermittent claudication].

In the treatment of peripheral obliterating arteriopathy (POA) physical training provides clear results in terms of increased walking autonomy; it is still not fully clear whether the positive effects of physical training can be further improved by concomitant back-up drug therapy. For this purpose 374 patients of both sexes, with a mean age of 64 years, suffering from chronic peripheral obliterating arteriopathy of the lower limbs were enrolled in a controlled open clinical trial, instructed to follow a programme of physical training and randomly allocated to low dose treatment with heparin calcium (12,500 IU/day) for 6 months. An improvement in the claudicometric parameters (free gait interval, absolute gait interval and recovery time) measured at constant speed and in the resting Winsor ankle/arm index of the most severely damaged limb were observed in both groups. These improvements were significantly greater in the group receiving pharmacological treatment (p < 0.01) and efficacy increased in line with basal deambulatory impairment. The results obtained and the good tolerance of the drug underline the clinical efficacy of heparin calcium at low doses in association with a physical training programme in patients suffering from Fontaine's stage II peripheral obliterating arteriopathy.

Analysis of Variance↗
PubMed1995

Reconstructive microsurgery of lymph vessels: the personal method of lymphatic-venous-lymphatic (LVL) interpositioned grafted shunt.

Our clinical observations in 64 patients affected by chronic obstructive lymphedema (either arm or leg) undergoing interposition autologous lymphatic-venous-lymphatic (LVL) anastomoses are reported. This microsurgical technique is an alternative to other lymphatic shunting methods, especially when venous dysfunction coexists in the same limb and, therefore, when direct lymphatic-venous anastomosis is accordingly inadequate. Preoperative diagnostic evaluation (including lymphatic and venous isotopic scintigraphy, Doppler venous flowmetrics, and pressure manometry) plays an essential role in assessing the conditions of both the lymphatic and venous systems and in establishing which microsurgical procedure, if any, is indicated. Our microsurgical technique consists of inserting suitably large and lengthy autologous venous grafts between lymphatic collectors above and below the site of obstruction to lymph flow. The data show that, using this technique, both limb function and edema improved, and in all patients followed up for over 5 years edema regression was permanent.

Anastomosis, Surgical↗
PubMed1995

Derivative lymphatic microsurgery: indications, techniques, and results.

Microsurgical derivative procedures to treat chronic lymphedemas of the limbs are reported here. Techniques used consisted of lymphatic capsule-venous anastomoses (in pediatric patients) and end-to-side lymphatic-venous anastomoses. Results after more than 5 years showed improvement in about 70% of the cases. The importance of an accurate preoperative diagnostic evaluation and the precise indications for these microsurgical procedures are discussed. Some personal modifications of derivative microsurgical techniques and their advantages are also pointed out.

Adult↗
PubMed1995

[Morphometric analysis of mammographic images in clinical oncology].

The three standard projections relative to mammographies of 40 patients with breast cancer pre-operatively classified as T1-T2 were analyzed by computerized morphometric elaborations. This method si able to better define view of images, permetting pre-operative connection of staging, with an increment of 30% if confronted with histologic TNM (pTNM). The utilization of method is discussed to evaluate the best way for the local definition of tumor extension, permitting to use a correctly conservative surgery (quadrantectomy, tumorectomy) in a greater number of patients.

Adult↗